Abstract

### Background

Open defecation is widely practiced in India. To improve sanitation and
promote better health, the Government of India (GOI) has instituted
large scale sanitation programmes supporting construction of public and
institutional toilets and extending financial subsidies for poor
families in rural areas for building individual household latrines.
Nevertheless, many household latrines in rural India, built with
government subsidies and the facilitation and support of non-government
organizations (NGO), remain unused. Literature on social, cultural and
behavioural aspects that constrain latrine adoption and use in rural
India is limited. This paper examines defecation patterns of different
groups of people in rural areas of Odisha state in India to identify
causes and determinants of latrine non-use, with a special focus on
government-subsidized latrine owners, and shortcomings in household
sanitation infrastructure built with government subsidies.

### Methods

An exploratory study using qualitative methods was conducted in rural
communities in Odisha state. Methods used were focus group discussions
(FGDs), and observations of latrines and interviews with their owners.
FGDs were held with frontline NGO sanitation program staff, and with
community members, separately by caste, gender, latrine type, and age
group. Data were analysed using a thematic framework and approach.

### Results

Government subsidized latrines were mostly found unfinished. Many
counted as complete per government standards for disbursement of
financial subsidies to contracted NGOs were not accepted by their owners
and termed as ‘incomplete’. These latrines lacked a roof, door, adequate
walls and any provision for water supply in or near the cabin, whereas
rural people had elaborate processes of cleansing with water post
defecation, making presence of a nearby water source important. Habits,
socialising, sanitation rituals and daily routines varying with caste,
gender, marital status, age and lifestyle, also hindered the adoption of
latrines. Interest in constructing latrines was observed among male
heads for their female members especially a newlywed daughter-in-law,
reflecting concerns for their privacy, security, and convenience. This
paper elaborates on these different factors.

### Conclusions

Findings show that providing infrastructure does not ensure use when
there are significant and culturally engrained behavioural barriers to
using latrines. Future sanitation programmes in rural India need to
focus on understanding and addressing these behavioural barriers.